Chronic muscle pain (myalgia) is a common problem throughout the world.

Seemingly simple, it is actually a difficult problem for the clinician interested in determining the aetiology of the pain, as well as in managing the pain.

The two common muscle pain conditions are Fibromyalgia and Myofascial Pain Syndrome.

Fibromyalgia is a chronic, widespread muscle tenderness syndrome, associated with central sensitisation. It is often accompanied by chronic sleep disturbance and fatigue, visceral pain syndromes like irritable bowel syndrome and interstitial cystitis.

Myofascial pain syndrome is an overuse or muscle stress syndrome characterised by the presence of trigger points in muscle.

The problem these syndromes pose lies not in making the diagnosis of muscle pain. Rather, it is the need to identify the underlying causes of persistent or chronic muscle pain in order to develop a specific treatment plan.

Chronic myalgia may not improve until the underlying precipitating or perpetuating factors are themselves managed.

Precipitating or perpetuating causes of chronic myalgia include structural or mechanical causes like scoliosis, localised joint hypo-mobility, or generalised or local joint laxity; and metabolic factors like depleted tissue iron stores, hypothyroidism or Vitamin D deficiency.

Rickets – the cause of fractures in a young baby whose parents were wrongly accused of his murder – was once almost eradicated.

But factors including poor diet and a lack of exposure to sunlight mean there has been an increase in cases of rickets in UK children in recent years. It affects the bones, causing them to become weaker and softer than normal. It can lead to serious bone deformities, such as bowed legs or curvature of the spine.

A lack of vitamin D and calcium is the most common cause. Our bodies absorb vitamin D from the action of sunlight on our skin and from foods such as oily fish, breakfast cereals and eggs.

Vitamin D is essential for a child to form strong and healthy bones because it helps the body absorb calcium from food. Rare forms of rickets can also be passed on from a parent to a child and, occasionally, rickets develops in children with rare forms of kidney, liver and intestinal conditions. Continue reading Child Dies of undiagnosed Rickets

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Osteoporosis is a condition where the bones become thin and weak, and break easily. It frequently goes undiagnosed until a fracture occurs, as there are no warning signs. The spine, wrist and hips are particularly vulnerable to fracture.

Osteoporosis symptoms

Occasionally a person develops a dowager hump or kyphosis at the top of their spine due to collapse of the vertebrae, and notices they have lost height. But mostly the thinning bones remain hidden away inside the body, with no symptoms or signs to alert someone to the fact that they have osteoporosis, until a minor bump or fall causes a bone fracture such as a broken hip or a crushed vertebrae. Continue reading Osteoprosis

Vitamin D is necessary for building bone. Older people often have low vitamin D levels through lack of exposure to sunlight and low dietary intake. Therefore, it has been suggested that taking additional vitamin D supplements may help to reduce the risk of hip and other fractures, which are very common in older people.

This Cochrane Review included 45 trials with 84,585 participants. The review found that taking vitamin D alone is unlikely to prevent fracture. Vitamin D taken with additional calcium supplements does appear to reduce risk of hip fractures in people living in institutional care. Although the risk of harmful effects from vitamin D and calcium is small, some people, particularly with kidney stones, kidney disease or high blood calcium, should seek medical advice before taking these supplements.